ASGE members may submit coding inquiries electronically to codingquestions@asge.org. Each month ASGE gets dozens of questions from members. When submitting a question, please allow at least three business days for a response. When submitting inquiries, please include the ASGE member’s name and ID number. Only questions will be accepted and not reports. Below are two questions that could be beneficial to your practice.
Question #1
Our provider performed a hemorrhoid banding on the 23rd. Before the patient left that day she was asked if there was any pinching or discomfort other than just pressure. She responded no. The patient went home and in the middle of the night was woken up with terrible discomfort. She called the office and came in on the 24th, the next day after banding to have it adjusted. To clarify, if nothing else was addressed and she came in as a result of the procedure from the previous day, we cannot bill for the E/M on the 24th, correct? If this is correct, does the provider still create the note for the 24th with the appropriate code, and it is written off as part of the procedure from the 23rd of February?
Answer
The global surgical package has three components: 0, 10 or 90-day packages. The hemorrhoid banding, CPT code 46222 is assigned a 10-day global package which means that any complications of the procedure are already factored into the development of the RVUs (relative value units) and no visit to address the complication is billable. Procedures done in the office setting are also included in treatment of the complications.
Only if the patient is returned to the OR setting can the procedure be billed, and modifier 78 would be assigned to the treatment code. If this is done in your office, your provider still has to complete the visit/procedure note and enter a charge into your system. CPT code 99024 (Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure) should be assigned with the diagnosis code of K91.89 (Other post-procedural complications and disorders of digestive system).
Question #2
If we are billing both the professional component (PC) and technical component (TC) on a Fibroscan, would we bill globally on the date the test was performed, even if it was a different day? Or would we bill the TC on date performed and PC on date read?
Answer
1. Global: You own the equipment and pay the salary of the provider that does the interpretation
2. Professional (modifier 26): You only provide the interpretation
3. Technical (modifier TC): You only provide the equipment, staffing, and supplies required for the testing
CMS last updated this policy on 2-1-2019
1. Global billing (no modifiers): Bill either the date of service/collection or date of interpretation
2. Interpretation only (modifier 26): Bill on the date of interpretation
3. Technical only (modifier TC): Bill on the date of service/collection
Commercial payers can vary their policies on the date of service, so best practice is to create a spreadsheet listing their date specifications on diagnostic studies.
Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE17023.pdf